Provider Demographics
NPI:1952772345
Name:VENCER HEALTH
Entity type:Organization
Organization Name:VENCER HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-267-6277
Mailing Address - Street 1:4955 S DURANGO DR
Mailing Address - Street 2:#207
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-0152
Mailing Address - Country:US
Mailing Address - Phone:702-267-6277
Mailing Address - Fax:
Practice Address - Street 1:4955 S DURANGO DR
Practice Address - Street 2:#207
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-0152
Practice Address - Country:US
Practice Address - Phone:702-267-6277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20151295293101YA0400X, 101YM0800X, 3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty